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The SpineMACAIRE GROBE, KATHERINE CALLAHAN, SOPHIA POWELL, BIN CHEN, AND THEO DIPAULI
Evolution of the Human SpineThe structure of the spine has changed significantly over the course of millions of years of evolution. Notochords in the first vertebraeThe development of the spinal cordTransition for humans to walk upright
http://factsanddetails.com/world/cat56/sub360/item1492.html
Walking Upright Bone and Joint Adaptions:
◦ Ability to lock our legs◦ Inward thigh bones◦ Arched foot◦ Gluteal Abductor
Spine Adaptions: ◦ Curved structure of the spine◦ Foramen Magnum
http://humanorigins.si.edu/human-characteristics/walking
Embryonic Development
Spine starts to form during 4th week of embryonic development
http://phys.org/news/2011-02-fetal-surgery-kids-spine-defect.html
5
Mesenchymal cells from the sclerotome of the somites start to form in three main areas: notochord, neural tube, and body wall
In the 6th week, chondrification occurs
Embryonic Development
http://imueos.wordpress.com/2010/09/26/development-of-musculoskeletal-system/
Curvature of the Spine
http://www.emory.edu/ANATOMY/AnatomyManual/back.html
http://blog.intellidance.ca/blog/2-15-2011/c-s-how-nurture-your-babys-spine-development
Biomechanics of Spinal InjuriesThe spine shares a similar structure to a flexible segmented column.Offers strong supportProne to various kinds of injuries
Fractures of the spine can be classified by:Causal MovementLocationShape Severity
http://www.bluechipspine.com/first-visit
Classifications of Fractures:
Three Column Concept Major and Minor Fractures
Classifications of Fractures:
Specific Fracture TypesStable vs. Unstable
Spinal Cord Injury: What is spinal cord injury?
◦ A spinal cord injury occurs when there is damage to the spinal cord either from trauma, loss of its normal blood supply, or compression from tumor or infection.
Why is it significant?◦ The spinal cord is incapable of healing itself.◦ Complete spinal cord injury: cannot send
signals below the level of injury. ◦ Incomplete spinal cord injury: some
movement and sensation below the injury.
Spinal Cord Injury: Causes:
◦ The most common cause of spinal cord injury is trauma.◦ Types of trauma include: falls from heights,
violence (stabbing or gunshot wounds to the spine), or sporting injuries (diving, football, rugby, equestrian, etc.)
◦ Spinal cord injury can also be caused by compression of the cord by a tumor, infection, or inflammation. ◦ Spinal stenosis
Conditions that affect the spinal cord:
• Tumors
• Infections such as meningitis and polio
• Inflammatory diseases
• Autoimmune diseases
• Degenerative diseases such as amyotrophic lateral sclerosis and spinal muscular atrophy
Diseases of the Spinal Cord: MeningitisPolioAmyotrophic lateral sclerosis (ALS) Spinal muscular atrophy (SMA)
Spine Treatment
Level 1: Mobilization and Physical Therapy
Level 2: Immobilization, Braces
Level 3: Spinal Surgery; Fusion, Disk Implants
Level 1: Mobilization and Physical Therapy Two components:
1. Passive physical therapy (heat/ice packs, ultrasound)2. Active Exercises (stretching)
Manual physical therapy:◦ Restore mobility ◦ Reduce muscle tension
Level 2: Immobilization, Braces Spinal bracing used for
treatment of: low back pain trauma infections muscle weakness neck conditions osteoporosis
Cervical Braces Soft and hard collars Philadelphia collar Sterno-occipital-mandibular
immobilization device (SOMI) Halo
Back Braces Two types of back braces commonly used:
1. Rigid braces2. Corset (elastic braces)
Level 3: Spinal Surgery; Fusion, Disk Implants Spinal FusionArtificial Disk Replacement (ADR)
Fusion Involves forming direct
connection between vertebrae surrounding the painful disc(s)
Pain relief occurs by stopping the motion of the painful disc(s).
Fusion
http://www.spine-health.com/video/interbody-spine-fusion-surgery-video
Artificial Disk Replacement (ADR)
Alternative to spinal fusion
replaces damaged or worn out spinal disc with an artificial disc
The Charité artificial disc is made of two metallic endplates and a plastic center
Artificial Disk Replacement (ADR)
http://www.spine-health.com/video/total-disc-replacement-back-surgery-video
Christopher Reeve
In 1995, famous actor Christopher Reeve broke his neck in a horseback riding incident.
Paralyzed from neck down and unable to breathe
Background on the injurySecond vertebrate (C2) causes instant death if displaced laterally by 5mmFracture in any cervical vertebrate causes quadriplegiaSpinal cord injuries breaks nerve fibers Destroys possible muscle movement in
distal direction
• Survived instant death• Survived 60-70% chance mortality rate over the following week• No recovery within 48 hours usually means no recovery
Spinal Cord Concussion Cervical Cord neurapraxia (CNN)
◦ Nerrowing of the spinal canal (stenosis)◦ Torg or Pavlov ratios:
◦ Ratio of canal diamter to vertebral body◦ 0.8< indicates significant for athletic
◦ Instantaneous loss of function of limbs but followed with complet recovery◦ Most commonly occurs at the cervical vertabrates
Torg. J. et al, 1997
Both techniques share the same level of reoccurrence
Torg. J. et al, 1997
How does it happen?Hyperextension, hyperflexion, axial load mechanisms on neckSpear tackleOccur in 7 out of 10,000 players per year
(1.8 million people) and rising
http://www.youtube.com/watch?v=UpdrHe31J-8
Why the rise? Helmets are too safe!
Long term effectsSymptoms subside usually after 24 hours
56% chance of reoccurrence
Repeat episode is directly proportional to diameter of player’s cervical spine canal
If neurologic symptoms persist surgery
Second episode termination of sport
Torg. J. et al, 1997
Case Study Example20 year old college defensive back
5 minutes of transient paralysis
C-3, 5 narrowing of 0.66
C-4 narrowing of 0.62
Minimal anterior subluxation
Returned to play after recovery
Minimal Flexion
… Fourteen months later
Contact is made with head
Classic spear tackle
Axial load
Fracture in the C4-C6 vertebrate
*Unilateral facet dislocation at C4-5 (C4 displaced anteriorly 25%) in sagittal plane
*Oblique fracture
*Three-part-two-plane fracture with small anterior fracture fragment
*Non-displaced sagittal fracture through the vertebral body and partial fracture of the right lamina
Help efforts Christopher and Dana Reeve
Paralysis Resource Center◦ Located in New Jersey◦ Funds for research, treatments/cures, for CNS disorders◦ Advocate improvement of quality of life post-injury◦ 22M to neuroscientist research◦ http://www.reevebigidea.org
References
41
[1] http://www.socalpaincenter.com/evolution-of-the-human-spine/[2] http://www.pbs.org/wgbh/evolution/library/07/1/l_071_02.html[3] http://web.indstate.edu/thcme/duong/EMBRYOL.html#anchor59130[4] http://blog.intellidance.ca/blog/2-15-2011/c-s-how-nurture-your-babys-spine-development[5] http://www.mayfieldclinic.com/PE-AnatSpine.htm#.VDXLLildW2o[6] http://imueos.wordpress.com/2010/09/26/development-of-musculoskeletal-system/http://www.allaboutbackandneckpain.com/researchingtreatmentrecovery/braces.asphttp://www.spineuniverse.com/treatments/bracing/neck-braces-type-spinal-bracehttp://www.spineuniverse.com/treatments/bracing/spinal-bracinghttp://www.ossur.com/injury-solutions/products/spine/spinal-traction/resolve-halohttp://www.spine-health.com/conditions/scoliosis/back-braceshttp://www.cocwindsor.com/tlsohttp://www.spinesurgery.com/non-surgical-treatments/lumbar-bracinghttp://www.spine-health.com/treatment/artificial-disc-replacement/all-about-charite-artificial-disc-now-approved-use-ushttp://www.washingtonpost.com/wp-dyn/articles/A99660-1995Jun1.htmlhttp://www.uscspine.com/conditions/sports-injuries.cfmhttp://www.spineuniverse.com/conditions/spinal-fractures/types-spinal-fractures